HomeMy WebLinkAbout2016 Nov 18 - Sign Off Transmittal Sheet, Floor Plans ��.: _ -.,--,�:�,,� , �.�., _ _ .. .ro.._ a_,
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„oY�Y�k,� � � TOWN OF YARMOUTH�.�r
' . i '�--� , ' HEALTH DEPARTMENT
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�� �cM�r PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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` 'ldi g Site Location: ( "i f�-�� �� �<-? - '
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Proposed Improvement: b e C.�('�o�� C, ��''�' �r`�` /n.. �� �P ,
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Applicant:��..��--F cz„_ �v G� --- C�v5 � v�.� TeL No.: �>� ��'�} '�2�
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**Ifyou woudd like e-mail not�cation ofsign off,please provide e-mail address:,�-+��(Z f C� ��� � `f'� ���,.,�,'�,C��y-�
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Owner Address: � � � ��'('�VJ��.. �r_ �,.�.�"�,��fa�•,,�- Owner Tel. No.:(�o�°'�6�! �Z Z`�
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-- RESIDENTIAL AND/OR COMMERCIAL BUILDING
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HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
�'�y� Please submit three (3) copies of plans, to include:
.�' (1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE: �1 l��jG`
PLEASE NOTE
COMMENTS/CONDITIONS: (
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RECEIVED
NO 18 2016
HEALTH DEPT
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Foc,or- Pta-p— RECEIVED
Nov 11 8 2016
HEALTH DEPT
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